ABSTRACT
INTRODUCCIÓN: El osteosarcoma es el tumor óseo maligno más común en la niñez y la adolescencia. Se desarrolla por orden de frecuencia en metáfisis distal de fémur, proximal de tibia y húmero proximal. La variedad de presentación de osteosarcoma telangectásico es rara, y afecta principalmente a niños y adolescentes. Las opciones de tratamiento quirúrgico son cirugía de salvamento y radical. Actualmente la mayoría de los tumores óseos malignos de la cintura escapular pueden seguir la primera opción. OBJETIVO: Presentar una técnica modificada de tenosuspensión para la reconstrucción de defectos humerales en el tratamiento quirúrgico del osteosarcoma de húmero. REPORTE DE CASO: Se presenta el caso de un varón de 16 años de edad con diagnóstico de osteosarcoma telangectásico de húmero tratado con cirugía de salvamento mediante técnica modificada de suspensión con peroné libre vascularizado para la reconstrucción del defecto humeral posterior a resección S345B según la Musculoskeletal Tumour Society (MSTS) y los resultados a 6 y 12 meses. RESULTADOS: A 6 meses del posquirúrgico existió consolidación del injerto sin complicaciones. A los 12 meses no se encontraron complicaciones. Los resultados funcionales fueron del 82 y 86% MSTS, respectivamente. CONCLUSIONES: La técnica modificada de suspensión de hombro utilizando peroné vascularizado y tendón del manguito rotador residual otorga resultados satisfactorios en el caso presentado, sin embargo, se requiere de mayor investigación para considerarla como modalidad de tratamiento generalizado en defectos humerales posterior a resección en bloque como tratamiento quirúrgico.
INTRODUCTION: El osteosarcoma is the most common malignant bone tumour in paediatric patients. The most frequent locations of osteosarcoma are the distal femur, the proximal tibia, and the proximal humerus. Telangiectatic osteosarcoma is rare, most commonly affecting children and adolescents. Surgical treatment options include limb sparing procedures and amputation, with most shoulder tumours currently being able to be treated without amputation. OBJECTIVE: To present a modified sling procedure to reconstruct humeral defects after bone resections in humeral osteosarcoma. CASE REPORT: A 16 year-old male patient with telangiectatic osteosarcoma of the proximal humerus was treated with limb sparing surgery. A modified sling procedure was performed using a vascularised fibular graft to reconstruct the humerus after in-block resection. Results at 6 and 12 months follow up are presented. RESULTS: Graft consolidation was observed at 6 months follow-up, and no complications were observed at 6 and 12 months follow-up. Functional results, according to the Musculoskeletal Tumour Society (MSTS), at 6 and 12 months were 82% and 86%, respectively. CONCLUSIONS: This modified sling procedure using a vascularised fibular graft and rotator cuff tendon showed satisfactory results in this case. Future studies should further evaluate its role in treating humeral defects after in-block resection.
Subject(s)
Humans , Male , Adolescent , Bone Neoplasms/surgery , Osteosarcoma/surgery , Plastic Surgery Procedures/methods , Humerus/surgery , Salvage Therapy , Fibula/blood supply , Fibula/transplantationABSTRACT
BACKGROUND: 10% of > 55-year-old adults suffer some kind of non-neoplastic knee pain and 75% of the musculoskeletal neoplastic disease develops in the knee. OBJECTIVE: to identify clinical characteristics of knee pain in neoplastic knee pathology. METHODS: after appropriate authorization of the Local Committee of Investigation and under informed consent, we made a crosssectional and a risk analysis study. We included 160 patients who were seeking medical help due to knee pain. They answered a standardized questionnaire relating to the characteristics of their pain symptomatology. Data were integrated into two groups with knee pain; a) neoplasic (cases, n = 65), b) non-neoplasic (controls, n = 95) and analyzed (SPSS v.15™). We used homogeneity tests between groups (p > 0.05); inferential analysis (Student t test, χ(2)) and risk assessment (OR), p ≤ 0.05, (CI 95%), Statistical power was > 0.80. RESULTS: female gender predominated (55%); age was 40.3 ± 19.6 years. The most prevalent diagnoses were knee osteoarthritis 37% for non-neoplasic group; giant cell tumor 10% for benign neoplasic group and osteosarcoma 6.1% for neoplasic malignant group. Knee pain lasting < 4 months (OR 7.6; CI 95% 3.48-16.5) and severe intensity (OR 5.7; CI 95% 2.82-11.64), constant pain (OR 2.9; CI 95% 1.37-6.36), rapidly progressive fluctuation (OR 31; CI 95% 7.01-137) and nocturnal predominance (OR 7.72; CI 95% 3.2-18.5) were characteristics of neoplasic knee pain. CONCLUSIONS: the neoplasic knee pain was characterized for a rapid onset, severe and constant pain, progressive, fluctuation and predominantly by night-time.
